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Clinical science
The use of positron emission tomography/CT in the diagnosis of tuberculosis-associated uveitis
  1. Deshka Doycheva1,
  2. Christoph Deuter1,
  3. Juergen Hetzel2,
  4. Julia-Stefanie Frick3,
  5. Phillip Aschoff4,
  6. Eva Schuelen2,
  7. Manfred Zierhut1,
  8. Christina Pfannenberg4
  1. 1Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
  2. 2Department of Internal Medicine II, University of Tuebingen, Tuebingen, Germany
  3. 3Institute of Medical Microbiology and Hygiene, University of Tuebingen, Tuebingen, Germany
  4. 4Department of Radiology, University of Tuebingen, Tuebingen, Germany
  1. Correspondence to Dr Deshka Doycheva, Centre for Ophthalmology, University of Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany; deshka.doycheva{at}med.uni-tuebingen.de

Abstract

Background Detection of tuberculosis as the underlying disease in uveitis can be problematic because of the limited sensitivity of conventional diagnostic methods, especially in the case of latent infection. The aim of our study was to evaluate the clinical usefulness of 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) in patients with uveitis and positive interferon-γ release assay.

Methods We screened 95 patients with different uveitis forms by QuantiFERON TB-Gold test. Positive results were found in 24 cases. 18F-FDG-PET/CT was performed in 20 QuantiFERON-positive patients. PET/CT images were evaluated for the presence, size and metabolic activity of hilar and mediastinal lymph nodes and pulmonary lesions.

Results In nine patients (45%) PET/CT detected increased FDG uptake in mediastinal or hilar lymph nodes. In two patients Mycobacterium tuberculosis was detected in culture after PET/CT-guided lymph node biopsy. In seven patients (35%) with serpiginous choroiditis partly calcified lymph nodes without FDG-uptake were found. Remission of uveitis was achieved in nine of 11 (82%) anti-tuberculosis-treated patients with progressive course of uveitis.

Conclusion In QuantiFERON-positive patients with severe uveitis forms, such as serpiginous choroiditis and occlusive retinal vasculitis, 18F-FDG-PET/CT is useful to identify lesions appropriate for biopsy and helps to establish the diagnosis and appropriate therapy for presumed tuberculosis-induced intraocular inflammation.

  • Uveitis
  • tuberculosis
  • 18F-FDG-PET/CT
  • diagnosis
  • immunology
  • infection
  • imaging
  • diagnostic tests/investigation

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Footnotes

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Ethics Committee of University of Tuebingen, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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